Oral injuries in children less than 24 months of age in a pediatric emergency department

Woolf, Seth M.; Leventhal, John M.; Gaither, Julie R.; Hardikar, Priyanka; Langhan, Melissa L.; Bechtel, Kirsten; Auerbach, Marc; Tiyyagura, Gunjan

doi:10.1016/j.chiabu.2019.01.006

Cited by 7 publications

(5 citation statements)

References 26 publications

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“…Nineteen (26%) studies focused specifically on injury patterns of abused children, and the likelihood of child abuse among patients presenting with fractures, head trauma, and oral injuries. 71 , 75 , 81 , 82 , 86 , 91 , 95 , 97 , 99 , 101 , 107 , 109 – 111 , 113 , 115 , 117 , 119 , 127 About 22 (31%) studies focused specifically on child sexual assault cases, 70 , 79 , 80 , 96 , 98 , 106 , 112 , 116 , 118 , 120 , 123 , 125 , 130 , 132 , 133 , 141 with six of these studies looking at sexually transmitted infection (STI) and pregnancy testing, STI prophylaxis, and the use of sexual assault nurse examiners. 77 , 78 , 121 , 122 , 140 , 150 Two of three review publications focused on screening, 154 , 155 with one publication focusing on improving the ED workflow for suspected or confirmed child abuse cases.…”

Section: Resultsmentioning

confidence: 99%

A Scoping Review of Current Social Emergency Medicine Research

Shah

Porta

Leung

et al. 2021

WestJEM

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Introduction: Social emergency medicine (EM) is an emerging field that examines the intersection of emergency care and social factors that influence health outcomes. We conducted a scoping review to explore the breadth and content of existing research pertaining to social EM to identify potential areas where future social EM research efforts should be directed. Methods: We conducted a comprehensive PubMed search using Medical Subject Heading terms and phrases pertaining to social EM topic areas (e.g., “homelessness,” “housing instability”) based on previously published expert consensus. For searches that yielded fewer than 100 total publications, we used the PubMed “similar publications” tool to expand the search and ensure no relevant publications were missed. Studies were independently abstracted by two investigators and classified as relevant if they were conducted in US or Canadian emergency departments (ED). We classified relevant publications by study design type (observational or interventional research, systematic review, or commentary), publication site, and year. Discrepancies in relevant publications or classification were reviewed by a third investigator. Results: Our search strategy yielded 1,571 publications, of which 590 (38%) were relevant to social EM; among relevant publications, 58 (10%) were interventional studies, 410 (69%) were observational studies, 26 (4%) were systematic reviews, and 96 (16%) were commentaries. The majority (68%) of studies were published between 2010–2020. Firearm research and lesbian, gay, bisexual, transgender, and queer (LGBTQ) health research in particular grew rapidly over the last five years. The human trafficking topic area had the highest percentage (21%) of interventional studies. A significant portion of publications -- as high as 42% in the firearm violence topic area – included observational data or interventions related to children or the pediatric ED. Areas with more search results often included many publications describing disparities known to predispose ED patients to adverse outcomes (e.g., socioeconomic or racial disparities), or the influence of social determinants on ED utilization. Conclusion: Social emergency medicine research has been growing over the past 10 years, although areas such as firearm violence and LGBTQ health have had more research activity than other topics. The field would benefit from a consensus-driven research agenda.

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Section: Resultsmentioning

confidence: 99%

A Scoping Review of Current Social Emergency Medicine Research

Shah

Porta

Leung

et al. 2021

WestJEM

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“…To our knowledge, only one study, however, has examined the impact of a child abuse pathway in CEDs in the United States, and that study did not find improved compliance with guidelines from the American Academy of Pediatrics (AAP) about management of suspected physical abuse 23 . Therefore, we developed a novel clinical pathway aimed at increasing the CED providers’ access to child abuse experts to aid in the evaluation of injuries associated with child abuse 24–31 …”

Section: Problem Descriptionmentioning

confidence: 99%

“…One such intervention leveraged the previously described facilitators and addressed the challenges of recognizing injuries concerning for abuse by implementing a clinical pathway. This clinical pathway directed CED providers to call the regional CPT at YNHCH for a phone consultation if any of the following 10 injuries associated with abuse 24–31 were noted in infants during the ED visit: 1) long‐bone fracture; 2) skull fracture; 3) rib fracture; 4) intracranial injury; 5) burn; 6) solid‐organ injury (laboratory or imaging evidence); 7) bruising of the ear, neck, torso, angle of jaw, cheek, or eyelid or patterned bruising; 8) subconjunctival hemorrhage; 9) frenulum tear; or 10) if the patient was < 5 months of age and had any oral injury or any bruise (Data Supplement S1, Figure S1, available as supporting information in the online version of this paper, which is available at http://onlinelibrary.wiley.com/doi/10.1111/acem.14132/full). In contrast to previously published pathways that prescribed a specific diagnostic evaluation, we recommended a case‐specific diagnostic evaluation dependent on advice from the CPT (i.e., a second opinion).…”

Section: Problem Descriptionmentioning

confidence: 99%

“…23 Therefore, we developed a novel clinical pathway aimed at increasing the CED providers' access to child abuse experts to aid in the evaluation of injuries associated with child abuse. [24][25][26][27][28][29][30][31] Rationale In a study that examined providers' experiences with child abuse, CED providers described challenges they had in distinguishing abusive from nonabusive injuries and their desire for more help with decision-making about suspected abuse. 32 To improve child abuse recognition, we developed and implemented a program in six CEDs in Connecticut known as the "CED Child Abuse Program," which facilitates enhanced relationships between CEDs, a regional hospital's child protection team (CPT) at Yale New Haven Children's Hospital (YNHCH) and CPS.…”

Section: Available Knowledgementioning

confidence: 99%

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Child Protection Team Consultation for Injuries Potentially Due to Child Abuse in Community Emergency Departments

Tiyyagura

Emerson

Gaither

et al. 2020

Academic Emergency Medicine

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Objectives Emergency care for children is provided predominantly in community emergency departments (CEDs), where abusive injuries frequently go unrecognized. Increasing access to regional child abuse experts may improve detection of abuse in CEDs. In three CEDs, we intervened to increase involvement of a regional hospital child protection team (CPT) for injuries associated with abuse in children < 12 months old. We aimed to increase CPT consultations about these infants from the 3% baseline to an average of 50% over 12 months. Methods We interviewed CED providers to identify barriers and facilitators to recognizing and reporting abuse. Providers described difficulties differentiating abusive from nonabusive injuries and felt that a second opinion would help. Using a plan‐do‐study‐act approach, beginning in April 2018, we tested, refined, and implemented interventions to increase the frequency of CPT consultation, including leadership and champion engagement, provider training, clinical pathway implementation, and an audit and feedback process. Data were collected for 15 months before and 17 months after initiation of interventions. We used a statistical process control chart to track CPT consultations about children < 1 year old with high‐risk injuries, use of skeletal surveys (SSs), and reports to child protective services (CPS). Results Evidence of special cause was identified beginning in June 2018, with a shift of 8 points to one side of the center line. For the subsequent 8‐month period, the CPT was consulted for a mean of 47.5% of children with high‐risk injuries; this was sustained for an additional 7 months. The average percentage of infants with high‐risk injuries who received a SS increased from 6.7% to 18.9% and who were reported to CPS increased from 10.7% to 32.6%. Conclusion Targeted interventions in CEDs increased the frequency of CPT consultation, SS use, and reports to CPS for infants with high‐risk injuries. Such interventions may improve recognition of physical abuse.

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“…Humans are entwined with problems that they cause themselves, this problem makes humans as a lost direction and purpose. (Woolf et al, 2019) Humans who have desires that are fulfilled, because the desires and desires that win over lust and excessive desire then fails to develop. This causes more and various kinds of problems it faces (Wood et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Judgment Considerations Regarding Decisions about Child Sex Abuse Crime Conducted by Military Member

Putri¹

2020

JLLR

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TNI and Children are the two parties that are protected by special laws and regulations. Members of the TNI are committed and submit to military legislation. Apparatus who committed crimes have to follow the military’s criminal law and military court. Meanwhile, children as the victims of criminal acts have the rights that are legally protected in the legislation on child protection. The problems on this research are (1) How is Implementation of Act No. 35 of 2014 About Child Protection against child sex abuse committed by TNI in Judicial Process at Military Court II-10 Semarang? (2) How does the judge’s consideration about the Criminal adjudication to the suspect of the child sex abuse committed by TNI (Case Study of Military Court II-10 Semarang’s Verdict No. 62-K/PM.II-10/AD/IX/2016)? This study uses a qualitative method located in Indonesia with a Verdict as the object of research. The data collection techniques using document and literature study. The result of research, 1) Implementation of Act No. 35 of 2014 About Child Protection in Judicial Process at Military Court II-10 Semarang, i.e (1) Arresting the defendant (2) Giving the child as a victim an opportunity to speak up some testimony (3) The result of Visum et Repertum as a Health service (4) Giving detention and forfeit to defendant along with dismissal from military service 2) Judge's consideration of the Criminal adjudication of perpetrators of the Child Sex Crimes committed by TNI (1) Juridical considerations, i.e : Indictment, testimony of witnesses and defendants, expert's testimony, evidence and other articles in the Child Protection Law (2) Non-Juridical Considerations are mitigating and aggravating factors. The conclusion of this research is that the Implementation of Act no. 35 of 2014 has not been fully implemented in the judicial process in Military Court II-10 Semarang, the child’s identity in the previous verdict is not disguised. Suggestion from this study is the punishment of the defendant should refer to Act no. 35 of 2014 on Child Protection and after the judicial process the parties including law enforcement should provide protection for the future of the child as a victim.

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Oral injuries in children less than 24 months of age in a pediatric emergency department

Cited by 7 publications

References 26 publications

A Scoping Review of Current Social Emergency Medicine Research

A Scoping Review of Current Social Emergency Medicine Research

Child Protection Team Consultation for Injuries Potentially Due to Child Abuse in Community Emergency Departments

Judgment Considerations Regarding Decisions about Child Sex Abuse Crime Conducted by Military Member

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